Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Feb 11;25(1):58.
doi: 10.1186/s13054-021-03469-w.

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Ricard Mellado-Artigas  1 , Bruno L Ferreyro  2   3 , Federico Angriman  3   4 , María Hernández-Sanz  5 , Egoitz Arruti  6 , Antoni Torres  7   8   9 , Jesús Villar  8   10   11 , Laurent Brochard  3   11 , Carlos Ferrando  12   8 ; COVID-19 Spanish ICU Network
Collaborators, Affiliations
Multicenter Study

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Ricard Mellado-Artigas et al. Crit Care. .

Abstract

Purpose: Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19.

Methods: We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding.

Results: Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days) and a reduction in ICU length of stay (mean difference: - 8.2 days; 95% CI - 12.7 to - 3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64).

Conclusions: The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

Keywords: Acute hypoxemic respiratory failure; COVID-19; High-flow nasal oxygen; Ventilator-free days.

PubMed Disclaimer

Conflict of interest statement

A. Torres reports lecturing or consultancy fees from Pfizer, MSD, Basilea, Biomerieux. Jansen. L. Brochard's laboratory reports grants from Medtronic Covidien, grants and non-financial support from Fisher Paykel, non-financial support from Air Liquide, Sentec, Philips, and a patent with General Electric, outside the submitted work. The remaining authors declare no conflicts of interest in relation to this manuscript.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Effect of a conservative approach (use of high-flow nasal oxygen) compared to early intubation on main outcomes of interest for patients with COVID-19 associated acute respiratory failure. Difference is expressed as mean difference for continuous variables or absolute risk difference for in-hospital mortality. In-hospital mortality in both groups expressed as cumulative incidence. CI: Confidence interval. HFNO: high-flow nasal oxygen. (1) Cumulative incidence and cumulative incidence difference (i.e., risk difference; 95% CI) reported for both groups. Results for ventilator-free days and intensive care unit length of stay were rounded up or down to the closest whole number
See this image and copyright information in PMC

References

    1. Ferreyro BL, Angriman F, Munshi L, et al. Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis. JAMA. 2020;324(1):57–67. doi: 10.1001/jama.2020.9524. - DOI - PMC - PubMed
    1. Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019;45(5):563–572. doi: 10.1007/s00134-019-05590-5. - DOI - PubMed
    1. Azoulay E, Pickkers P, Soares M, et al. Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study. Intensive Care Med. 2017;43(12):1808–1819. doi: 10.1007/s00134-017-4947-1. - DOI - PubMed
    1. Ricard JD, Roca O, Lemiale V, et al. Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med. 2020 doi: 10.1007/s00134-020-06228-7. - DOI - PMC - PubMed
    1. Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med. 2017;195(4):438–442. doi: 10.1164/rccm.201605-1081CP. - DOI - PubMed

Publication types